05997 (SFD)I
State, Lic.
& Classif.
';,,Arch., Engr;
D i -
el.:'
Lic. # 328
Tel.
cityZi State
lI p Lic. #
LICENSED CONTRACTOR'S DECLARATION
Sq. Ft. 2596 No.
Size Stories
No. Dw.
Units..','+,
New4Q Add 0 Alter 0 Repair 0
Dem0: lition 0
• 71 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Of Division 3 of the Business and Professions Code; and my license Win full force and.*
.if
ect
effect:
4.
• SIGNATURE DATE
OWNER -BUILDER DECLARATION.
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
179,818.00
reason: (Sec. 7031.5,Business and Professions Code: Any city.or county which requires a
• permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
I
requires the applicant for such permit to.file a signed statement that he is licensed.pursuant to
PERMIT
AMOU NT
the provisions of the Contractor's License Law, Chapter 9,(commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 by.any
Plan Chk.-Dep. -
alleged exemption. violation of applicant for a permit
.T subjects the applicant to civil penalty ofnot more than rive huhdred dollars ($500).
Plan Chk. Bal,__
0 1, as owner of the property, or my employees with wages as their sole compensation, will
P.O. BOX 1504
No.
05997,
Building
Professions Code: The Contractor's License Law does not apply to an owner of property who
78-105 CALLE ESTADO
builds or improves, thereon and who does such work himself or -through his own employees.'
, . - C"..
Address
.54-401
-Soutbern Hills
LA QUINTA, CALIFORNIA 92253
or improvement is sold within one year of completion, the owner -builder will have the burden.
Electrical _Z'
Owner
Sunrise Co.
_134 t2_15.
0 1, as owner of theproperty, am exclusively contracting with licensed contractors to con-
Mailing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of who builds for
improves thereon,S.M.I.
BUILDING: tTYPE CONST. m•
OCC,.*GRP.-
property or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Address
75-005
c6uyttry Club
A�..P, Number
0 1 am exempt under Sec. B. & P.C.-for this reason
CityZ
ip
Tel.
`Date —Owner
Infrastructure
P.D,
92260
Legal Description
568-2828
Contractor
Infra fte
iiPh";-- 140
Project Description '
Plan 20M
7
.. 5
same
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
Address
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS. COMPENSATION INSURANCE
REMARKS'
I
State, Lic.
& Classif.
';,,Arch., Engr;
D i -
el.:'
Lic. # 328
Tel.
cityZi State
lI p Lic. #
LICENSED CONTRACTOR'S DECLARATION
Sq. Ft. 2596 No.
Size Stories
No. Dw.
Units..','+,
New4Q Add 0 Alter 0 Repair 0
Dem0: lition 0
• 71 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Of Division 3 of the Business and Professions Code; and my license Win full force and.*
.if
ect
effect:
• SIGNATURE DATE
OWNER -BUILDER DECLARATION.
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
179,818.00
reason: (Sec. 7031.5,Business and Professions Code: Any city.or county which requires a
• permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
I
requires the applicant for such permit to.file a signed statement that he is licensed.pursuant to
PERMIT
AMOU NT
the provisions of the Contractor's License Law, Chapter 9,(commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 by.any
Plan Chk.-Dep. -
alleged exemption. violation of applicant for a permit
.T subjects the applicant to civil penalty ofnot more than rive huhdred dollars ($500).
Plan Chk. Bal,__
0 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves, thereon and who does such work himself or -through his own employees.'
Mech.
I
provided that improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden.
Electrical _Z'
of proving that he did not build or improve for the purpose of sale.)
_134 t2_15.
0 1, as owner of theproperty, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of who builds for
improves thereon,S.M.I.
property or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. B. & P.C.-for this reason
Driveway Enc.
`Date —Owner
Infrastructure
4045.90
iless (Zedit
WORKERS' COMPENSATION DECLARATION
Infra fte
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Se6. 3800, Labor Code.)
7
.. 5
Policy No. Company•
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS. COMPENSATION INSURANCE
REMARKS'
L14— A LR
M
S
(This action need not be completed if the permit is for one hundred dollars ($100) valuation
j,,7M44. 1,14 ;,6i '004 .�4�
or less.)
I certify that in the Performance of thp work for which this permit is issued, I shall not
any person in any manner so as to become subject,to the Workers' Compensation
=
Cal,fornia.
Date �_Qwn&
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
ZONE: -
subject . to theWorkers' Compensation provisions of the Labor Code, you must forthwith
• comply with such provisions or this permit shall be deemed revoked. y
—BY:—
Minimum Setback Distances:.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
• CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line'
Ihereby affirm that there is a construction lending agency for the performance of the
workfor
which this, permit is issued. (Sec. 3097. Civil Code.)
Side Setback from om Property Line
Lender's Name
I
Lenders Address
'This is a building permit when ptoperly filled out, signed and.validated, and iSrsubject to
FINAL DATE
—INSPECTOR
expiration it work thereunder is suspended for 180 days.
.
6719--8
I certify
tify that I have read this application and state that the above information is co
correct
Issued by:
Date Permit
I agnee'tb'cornply with all city and'county ordinances and state laws relating to building
construction, and hereby -authorize representatives -of this city to enter the above-.'
mentioned property for inspection purposes. I .
Validated by:
Signature of applicant Date
Maili ' ng Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
F RMS
EWER OR SE TA
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SQ. Ff.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ®c I
IBATH TUB
9fUCATION/SOUND 3
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 77
ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE „ PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SCK
ROUND PLUMBING r)
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F RMS
EWER OR SE TA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP. /
FINAL INSP.
OFING /0yZr
REMARKS:
VENTILATION[
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
HI
14 Cd
MESH
9fUCATION/SOUND 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUAESIINITIALS
GARDEN WALL FINAL
1